Making unresectable hepatic colorectal metastases resectable--does it work?

In patients with colorectal liver metastases, surgical resection is the treatment of choice. Reported 5-year survival rates with surgical resection range from 40% to 58%. The definition of resectability has changed over the past decade from a limited number of metastases (three to four) to any number of metastases as long as resection can be completed with anticipated negative surgical margins. In patients with bilobar hepatic colorectal metastases, potentially curative resection after preoperative chemotherapy may be possible only with an extended hepatectomy (bilobar hepatic resection of five or more hepatic segments). Extended hepatic resection should be considered because it is associated with a near-zero mortality rate with modern surgical techniques. If the estimated volume of liver that remains after resection is too small to permit safe extended hepatectomy (ie, 20% or less of the total estimated liver volume), preoperative portal vein embolization can be safely used to increase the volume of the future liver remnant and improve postoperative liver function. Other approaches for patients with bilobar metastases include two-stage hepatic resection and the combined use of resection with radiofrequency ablation.